Provider Demographics
NPI:1124127162
Name:PECK, STEPHEN L (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:PECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1717 SHAFFER ST
Mailing Address - Street 2:SUITE 232
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1647
Mailing Address - Country:US
Mailing Address - Phone:269-226-5050
Mailing Address - Fax:269-226-5034
Practice Address - Street 1:1717 SHAFFER ST
Practice Address - Street 2:SUITE 232
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1647
Practice Address - Country:US
Practice Address - Phone:269-226-5050
Practice Address - Fax:269-226-5034
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301038298207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI25-31067OtherPHP/IBA
MISP038298OtherBCBS
MEP54643OtherBCN
MI1394115Medicaid
MIB46952Medicare UPIN
MIB46952Medicare UPIN